Most of us hope to live in our own home for all of our days. However, sometimes we need to make other arrangements for our loved one’s safety and our own peace of mind. Clearly, we worry about the people for whom we care when we think they are "at risk" when living alone. How we go about considering all the issues involved in making the decision to find an alternative living situation can be confusing and an emotionally trying experience.

There are several alternatives to our older family members living alone, including bringing services into the home and staying there, house sharing with another individual who provides care, senior housing with some services, Continuing Care Retirement Communities, living with family members and others. Each of these "alternatives" has benefits and limitations. The success of each option depends largely on the specific abilities and needs of the individual. Our attention here is on making the decision for a loved one to move to a higher level of care when living "independently" is no longer a safe option.

There are several things caregivers should consider when making a decision about the best environment for their loved one. It should begin with the actual condition and needs of the individual and their potential to return to a higher level of functioning and more independence. A temporary transition to a rehabilitation facility is generally well tolerated by most because it helps us return to higher level of functioning and then we often "go back home." However, when the need for more care is permanent, there is much to consider and do to pick the "right" place for our loved ones.

When we are determining whether an Assisted Living Facility or Nursing Care Facility is best for your loved, we examine specific clinical criteria such as their ability to participate in activities of daily living, personal care self-management, communication skills, continence, medical condition, etc. A full medical evaluation is recommended, especially if there have changes in the loved one’s condition and capacity. Are the loved one’s needs primarily physical frailness and disability or cognitive and memory impairment? What can your loved one do for themselves? What does the family do for them? Is cueing enough to support the individual or are more hands-on services required?

Large and constant physical disability tends to indicate Nursing Care, while poor memory and a need for cuing tends to indicate Assisted Living. Although, at times the proper level of care is clear, often there is more complexity to making the proper determination requiring professional guidance and support.

This complexity can be sorted out with consultation from your medical provider and local Medical Social Workers. Many facilities have specific guidelines on what indicates Assisted Living and Nursing Care. They can also guide you in this determination.

Once you know that you need a higher level of care, begin the process of finding the very best one that you can afford and the family can get to on a regular basis!

Preparing your loved one for this transition is likely to be difficult. You will need to educate yourself about options, services, costs, etc. to help, guide and support your loved one through this significant change in their life. Begin the conversation expressing your concern about their long term wellness and safety. Recognize that they have done well up to now, however, their condition has changed and their health requires more than you can provide at home.

This conversation should not be rushed or taken lightly. It will take time and perhaps several discussions before you, your loved one and your family members are all in agreement. You should make it clear that you recognize how large a decision this is and not try to minimize it in any way.

There are individuals who are skilled at assisting in this decision making process and working through the issues related to determining when a loved one could benefit from Assisted Living or Nursing Care:
  • Medical Social Workers at your local hospital
  • Your loved one’s Physician and Medical Team
  • Home Care Nurses and Social Workers if your receive Home Care

Featured Partners & Friends

Given the many crucial issues surrounding the physical, mental, emotional, and lifestyle demands associated with caregiving, it’s important for families to be aware of where to go for answers, support, and encouragement.


Alzheimer's Disease Research Center

Caring for a Loved One with Alzheimer's Disease: A Guide for the Home Caregiver
by Peter Rabins, M.D., MPH, and Ann Morrison, RN, Ph.D.

firstSTREET Online

Health Style Press

Lotsa Helping Hands

Meals on Wheels

National Alliance For Caregiving

National Area Agencies on Aging

United Health Care